Changes in the number and significance of pharmacist interventions at an outpatient chemotherapy clinic between 2009 and 2013

Abstract

Background Historically, at the site of the present study, chemotherapy orders were screened by a junior Grade 1/2 pharmacist. An audit in 2009 of pharmacy interventions when screening chemotherapy charts highlighted the need for a senior oncology pharmacist (SOP) to help improve the clinical service and patient safety. In October 2012 an integrated cancer care centre (ICCC) was opened where all outpatient chemotherapy was administered. The SOP was appointed and based in the ICCC. Aim To compare the number and significance of pharmacist interventions made when screening chemotherapy charts in the ICCC Pharmacy in 2013 with the results of a similar audit conducted in 2009 prior to the opening of the ICCC and the recruitment of a dedicated SOP. Methods Pharmacists prospectively recorded interventions and their outcome while screening outpatient chemotherapy charts in 2013. Interventions were separated into haematology and oncology specialties. Two ICCC pharmacists and the registrar of the corresponding specialty separately assessed the interventions, considering the consequence of impact and the likelihood of reoccurrence. Discrepancies were discussed and a decision reached. Results were compared with the previous audit in 2009. Results All interventions (2013) resulted in changed chemotherapy prescriptions. There were 90 pharmacist interventions over a 3‐month period in 2013 compared with 201 pharmacist interventions over a 3‐month period in 2009. The majority were low risk (2009: 54% (109/201); 2013: 62% (56/90); p = 0.126). There was no change in moderate or extreme risk interventions. There was a significant decrease in high‐risk interventions from 2009 to 2013 (18% (37/201) vs 1% (1/90), respectively; p < 0.001). Conclusion The introduction of a dedicated SOP and an ICCC has coincided with a reduced number of high‐risk pharmacist interventions. Better communication between physicians and pharmacy, and an increased pharmacist presence in the treatment centre, all potentially impact positively on patient safety.

Methods in pharmacy practice research – using the palette ingeniously

“…Here the authors examine the inpatient chart before the introduction of the CPOE, the CPOE with the antimicrobial approval system, and then the CPOE alone – depending on which data was available in each time period. In a similar vein, the study by McInerney et al . of pharmacist interventions at an outpatient chemotherapy clinic used audits done at two separate times to investigate whether a new integrated cancer centre improved pharmacists’ impact.…”